HOSPITAL STRATEGY IN THE ERA OF UNIVERSAL HEALTH COVERAGE. Dr.dr.Sutoto,M.Kes Chairman of the Indonesian Hospital Association

Transcription

1 HOSPITAL STRATEGY IN THE ERA OF UNIVERSAL HEALTH COVERAGE Dr.dr.Sutoto,M.Kes Chairman of the Indonesian Hospital Association

2 CORE DISCUSSION

3 SOCIOECONOMIC CHANGES IN INDONESIA AND IMPACTS CHANGES IN THE ERA OF UNIVERSAL HEALTH CARE COVERAGE

4 SOCIOECONOMIC CHANGES IN INDONESIA AND IMPACTS 5 (FIVE) INDICATIONS OFWHY INDONESIA WILL BE THE 7 TH LARGEST ECONOMY IN THE WORLD 1. Stable economic growth and forecast 2. Growth in urbanization. 90% of the national economic growth is contributed by cities outside of Java % of export is not from natural resources (oil and gas) 4. 7% decrease in labor intensive industries % of the economy is due to the increase in productivity Resource: McKinsey Global Institute presentation by Chairman Raoul Oberman, Indonesia s Vision for 2030, Indonesia s National Economic Committee, Ritz Carlton Hotel, 13/11/13

5 Ist: ECONOMIC LEVEL of INDONESIA IS ASSESSED AS MOST STABLE IN WORLD G 20 MEMBERS 90 % WORLD GDP 80 % total WORLD COMMERCE 2/3 % WORLD POPULATION

6 DEVELOPMENT Of ECONOMICS Of INDONESIA

7 GROWTH OF URBANIZATION 90% of the national economic growth is contributed by cities outside of Java

8 60 % OF ECONOMIC GROWTH SUPPORTED BY INCREASE IN PRODUCTIVITY

9 By 2030: 90 Million Indonesians could join the Consuming Class

10 HOSPITAL STRATEGY IN THE ERA OF UNIVERSAL HEALTH CARE COVERAGE 1. CORE STRATEGY 1. QUALITY IMPROVING QUALITY PERFORMANCE 2. EFFICIENCY IMPROVING EFFICIENCY 2. STEPS HOSPITAL STRATEGY TOWARD UNIVERSAL HEALTH COVERAGE /JKN 2. OVERALL HOSPITAL STRATEGY TOWARD UNIVERSAL HEALTH COVERAGE/JKN

11 STAGES IN IMPROVING QUALITY PERFORMANCE Primitive: You should do X (X= Regulation, Standard, Incentive) Medieval : You must do X Modern: X is norm (X= Check list, Default, Feed back, Loops ex: CP) Future : X is done (automation) Atul Gawande, MD, Plenary Speaker, ISQua International Conference 14 Oct Edinburgh, Scotland

12 THREE DIMENTION TOWARD UNIVERSAL HEALTH COVERAGE

13 FIRST DIMENSION: FINANCIAL PROTECTION What do people have to pay out of pocket? Coverage mechanism VS cost sharing and fee? WHAT DO PEOPLE HAVE TO PAY OUT OF POCKET? Around 150 million people suffer financial catastrophe each year and 100 million pushed into poverty because of out-ofpocket health care bills (1) PAYMENT SYSTEM : CAPITATION FOR PRIMARY CARE CASE BASE GROUP FOR SECONDARY AND TERTIARY CARE Resource: Health Systems Financing And The Path To Universal Coverage. David B Evans, Director, Health Systems Financing, Health Systems And Services Carissa Etienne, Assistant Director General, Health Systems And Services

14

15 HOW CAN THE MIDDLE CLASS BENEFIT FROM THE UNIVERSAL HEALTH CARE COVERAGE? COST SHARING TO COVER THEIR DIFFERENT NEEDS Patients that would like to stay in higher classes can pay the difference with private health insurance or out-of-pocket payment, Stated in Ministry of Health regulation PERPRES 12 TTG JAMINAN KESEHATAN. Clause 24 COVERAGE MECHANISM (PAID BY BPJS) COST SHARING COVERAGE MECHANISM (PAID BY BPJS) COST SHARING

16 SHIFT OF THE PATIENT AND THE ROLE OF HOSPITALS IN THE ERA OF UNIVERSAL HEALTH CARE COVERAGE RS BLU RS SN RS PT RS BLU RS SN RS BLU RS SN RS PT TAHUN 2014 PASIEN BPJS (Additional insurance coverage) PASIEN BPJS (100% coverage) PASIEN BPJS IUR BIAYA (With option to pay balance of payment owing) TAHUN 2019 PASIEN BPJS (Additional insurance coverage) PASIEN BPJS (100% coverage) PASIEN BPJS (With option to pay balance of payment owing)

17 TEN LEADING SOURCES OF INEFFICIENCY 1. Medicine: underuse of generics and higher than necessary price. 2. Medicine: use of substandard and counterfeit medicines. 3. Medicine: inappropriate and ineffective use. 4. Products and services: overuse/supply of equipment, diagnostic services and procedures. 5. Health workers: inappropriate or costly staff mix, unmotivated workers. 6. Health service: inappropriate hospital admission and length of stay. 7. Health service: inappropriate hospital size and low use of infrastructure. 8. Health service: medical errors and suboptimal quality. 9. Health system leakages: waste, corruption and fraud. 10. Health intervention: inefficient mix and inappropriate level. Resource: Health Systems Financing And The Path To Universal Coverage. David B Evans, Director, Health Systems Financing, Health Systems And Services Carissa Etienne, Assistant Director General, Health Systems And Services

18 STRENGTH AND WEAKNES ANALYSIS HAVE EVER SERVE JAMKESMAS Revenue From Jamkesmas > 50% Revenue From Jamkesmas <50% + - HOSPITAL HAVE NEVER SERVE JAMKESMAS Revenue From Askes dan Jamsostek >40 % Revenue From Askes / Jamsostek <40 %

19 MANAGEMENT SKILL TO CONTROL PHYSICIAN BEHAVIOUR MANAGEMENT SKILL TO CONTROL PHYSICIAN BEHAVIOUR POSITIVE NEGATIVE ADAPTATION PROCESS FASTER ADAPTATION PROCESS MORE SLOW

20 SIX STEPS HOSPITAL STRATEGY TOWARD UHC/JKN

21 OVERALL HOSPITAL STRATEGY IN THE ERA OF UNIVERSAL HEALTH CARE COVERAGE 1. Develop: New Standards must be based on the national standards of hospital accreditation 2. Use of : SPO s from the international adapted accreditation standards, formularium, Clinical pathways, checklists. 3. Train staff competence to execute: new accreditation standards, use of checklists, clinical pathways, ICD 10 and ICD 9 CM, INA CGBs and monitoring level of compliance with reward program.

22 OVERALL HOSPITAL STRATEGY IN THE ERA OF UNIVERSAL HEALTH CARE COVERAGE Medicines: 1. Improve: Electronic prescription, new prescribing guidance, compliance with standards and formularium, reduce duplication, poli pharmacy, drug interaction 2. Incentives and support for generic substitution 3. Regulate promotional activities, rational use etc. Good Hospital governance: 1. Provide more continuity of care and monitoring in hospitals, clinics, clinical staff performance, clinical Audit and other monitoring systems. 2. Implement awareness and execution of patient safety programs. Paying providers: Move away from fee for service to remuneration.

23